Living With HIV: Is Hypertension Adequately Addressed?

Abstract

Hypertension is an ongoing health concern for the aging U.S. population but is also a concern for people living with chronic disease. People with HIV are living longer and need to have their other medical conditions managed. Yet, care delivery is often disjointed and hypertension may be overlooked. Methods: A retrospective analyses of the longitudinal cohort data from the AIDS Linked to the Intra Venous Experience (ALIVE) study was conducted. Participants with HIV, followed between 7/1/2009 to 6/30/2012, and age >18 were examined. High blood pressure was defined as a systolic blood pressure>140 and a diastolic blood pressure >90 on two consecutive visits. Risk factors for hypertension were examined including behavioral (weight, smoking), disease/therapy related (treatment, viral load, and CD4 counts), and socioeconomics (homeless, social support, education). Results: The study sample included 368 HIV infected participants with a median age of 53. Nearly all were African American (93%) and 65% were male. The overall prevalence if uncontrolled hypertension was found to be 18%. In a multivariable logistic regression analysis, smoking >1 pack/day was independently associated with hypertension (OR=2.77; 95% CI, 1.13-6.67). People with a CD4 T-cell count of <200 cells.mm³ were two times more likely to have hypertension (OR=2.11; 95% CI, 1.05-4.25). Conclusions: The high prevalence of hypertension in the HIV infected ALIVE sample calls for improved care for a treatable comorbidity. Although 97% of the sample reported accessing clinical care in the past six months, 18% have uncontrolled hypertension. Moreover, the strong association between smoking and hypertension calls for targeted teaching and referral for treatment, whether detected in a research study like ALIVE or in primary care.